Layered braided aneurysm treatment device

ABSTRACT

A braided implant is provided that can secure within an aneurysm sac, occlude a majority of the aneurysm&#39;s neck, and at least partially fill the aneurysm sac. The implant can include a tubular braid that can be set into a predetermined shape, compressed for delivery through a microcatheter, and implanted in at least one implanted position. In some examples, the tubular braid can be implanted in two distinct implanted shapes, allowing for treatment of a wide range of aneurysm sizes. In some examples, the implanted braid can include a compaction resistant column spanning the height of the aneurysm.

FIELD OF INVENTION

The present invention generally relates to medical instruments, and moreparticularly, to embolic implants for aneurysm therapy.

BACKGROUND

Cranial aneurysms can be complicated and difficult to treat due to theirproximity to critical brain tissues. Prior solutions have includedendovascular treatment whereby an internal volume of the aneurysm sac isremoved or excluded from arterial blood pressure and flow. Currentalternatives to endovascular or other surgical approaches can includeintravascularly delivered treatment devices that fill the sac of theaneurysm with embolic material or block the entrance or neck of theaneurysm. Both approaches attempt to prevent blood flow into theaneurysm. When filling an aneurysm sac, the embolic material clots theblood, creating a thrombotic mass within the aneurysm. When treating theaneurysm neck, blood flow into the entrance of the aneurysm isinhibited, inducing venous stasis in the aneurysm and facilitating anatural formation of a thrombotic mass within the aneurysm.

Current intravascularly delivered devices typically utilize multipleembolic coils to either fill the sac or treat the entrance of theaneurysm. Naturally formed thrombotic masses formed by treating theentrance with embolic coils can result in improved healing compared toaneurysm masses packed with embolic coils because naturally formedthrombotic masses can reduce the likelihood of distention from arterialwalls and facilitate reintegration into the original parent vessel shapealong the neck plane. However, embolic coils delivered to the neck ofthe aneurysm can potentially have the adverse effect of impeding theflow of blood in the adjoining blood vessel, particularly if theentrance is overpacked. Conversely, if the entrance is insufficientlypacked, blood flow can persist into the aneurysm. Treating certainaneurysm morphology (e.g. wide neck, bifurcation, etc.) can requireancillary devices such a stents or balloons to support the coil mass andobtain the desired packing density. Once implanted, the coils cannoteasily be retracted or repositioned. Furthermore, embolic coils do notalways effectively treat aneurysms as aneurysms treated with multiplecoils often recanalize or compact because of poor coiling, lack ofcoverage across the aneurysm neck, blood flow, or large aneurysm size.

Alternatives to embolic coils are being explored, for example a tubularbraided implant is disclosed in US Patent Publication Number2018/0242979, incorporated herein by reference. Tubular braided implantshave the potential to easily, accurately, and safely treat an aneurysmor other arterio-venous malformation in a parent vessel without blockingflow into perforator vessels communicating with the parent vessel.Compared to embolic coils, however, tubular braided implants are a newertechnology, and there is therefore capacity for improved geometries,configurations, delivery systems, etc. for the tubular braided implants.For instance, delivery of tubular braided implants can require uniquedelivery systems to prevent the braid from inverting or abrading whenpushed through a microcatheter, and some simple delivery systems thatpush embolic coils through microcatheters from their proximal end maynot be effective to deliver tubular braids.

There is therefore a need for improved methods, devices, and systems forimplants for aneurysm treatment.

SUMMARY

It is an object of the present invention to provide systems, devices,and methods to meet the above-stated needs. Generally, it is an objectof the present invention to provide a braided implant that can securewithin an aneurysm sac and occlude a majority of the aneurysm's neck.The implant can include a tubular braid that can be set into apredetermined shape, compressed for delivery through a microcatheter,and implanted in at least one implanted position that is based on thepredetermined shape and the geometry of the aneurysm in which the braidis implanted.

In some examples presented herein, when compressed, the implant can besufficiently short to mitigate friction forces produced when the implantis delivered unsheathed through the microcatheter allowing for a moresimplistic delivery system compared to some other known braided embolicimplant delivery systems.

In some examples presented herein, when the implant is implanted, amajority of the aneurysm sac can be free from embolic material tofacilitate the formation of a thrombotic mass that is primarilynaturally formed.

In some examples presented herein, the tubular braid can be implanted intwo distinct implanted shapes, depending on the size of the aneurysm,allowing for treatment of a wider range of aneurysm sizes compared tosome other known braided embolic implants.

In some examples presented herein, when implanted, the tubular braid canhave a compaction resistant column extending across a majority of theheight of the aneurysm and positioned centrally within the aneurysm sac.

An example implant can include a tubular braid having an open end and apinched end. The tubular braid can have a predetermined shape that hastwo inversions that divide the braid into three segments. In thepredetermined shape, the braid can have an outer segment that extendsbetween the open end and a first of the two inversions, a middle segmentthat extends between the two inversions and is encircled by the openend, and an inner segment that extends between the second of the twoinversions and the pinched end of the tubular braid and is surrounded bythe middle segment.

When in the predetermined shape, the tubular braid can have a heightmeasured between the two inversions and a substantially radiallysymmetrical shape having an outermost diameter. The ratio of outermostdiameter to height can be between about 2:1 and about 1:3 or, morespecifically, between about 2:1 and about 1:1. In the predeterminedshape the middle segment can have maximum diameter that is equal to thediameter of the open end. When compressed, the tubular braid can beextended longitudinally to a single layer of braid having a lengthmeasured from the open end to the pinched end. The ratio of theoutermost diameter in the predetermined shape to length in thecompressed, delivery shape can be between about 0.2 and about 0.3.

The length of the tubular braid in the delivery shape can be betweenabout 10 mm an about 40 mm, depending on the size of the aneurysm beingtreated.

A collection of implants, each having a uniquely shaped tubular braidcan be created to provide a catalogue of implants for treating aneurysmsranging in diameter and height. Each implant in the collection can besuitable for treating aneurysms with a sub-range of diameters and a subrange of heights.

The tubular braid can have two distinct implanted shapes based on thepredetermined shape and constrained by the geometry of an aneurysm inwhich the tubular braid is implanted. In other words, the implant can beimplanted in either a larger aneurysm or a smaller aneurysm, the smalleraneurysm having a height measuring less than the height of the largeraneurysm, and the tubular braid can take one of the two implanted shapeswhen implanted in the larger aneurysm and the tubular braid can take onthe other of the implanted shapes when implanted in the smalleraneurysm. In either implanted shape, the first, outer segment of thepredetermined shape can be positioned to form an outer layer thatjuxtaposes/apposes an aneurysm wall and the inversion adjacent to theouter segment in the predetermined shape can be positioned to form aproximal inversion at an aneurysm neck. When implanted in the largeraneurysm, the second, middle segment of the predetermined shape can forma sack that apposes a portion of the aneurysm wall and apposes the outerlayer of the braid, the pinched end can be suspended within the sack ofthe braid, and the open end can encircle the sack. When implanted in thesmaller aneurysm, the middle segment of the predetermined shape can befolded to form a middle layer that apposes the outer layer and an innerlayer that apposes the middle layer, the open end can be positioned nearthe fold dividing the middle and inner layers, and the pinched end canbe positioned near the proximal inversion and aneurysm neck. The tubularbraid in the predetermined shape can have a bend in the middle, secondsegment, and when tubular braid is in the smaller aneurysm implantedshape, the middle segment can fold at the bend to separate the middlelayer from the inner layer.

An example implant having the tubular braid having two distinctimplanted shapes can treat aneurysms within a range of sizes includingan aneurysm having a diameter of 4 mm and a height of 6 mm, an aneurysmhaving a diameter of 5 mm and a height of 8 mm, and an aneurysm having adiameter of 6 mm and a height of 6 mm. Additionally, or alternatively,the implant can be suitable for treating aneurysms within a continuum ofaneurysm sizes, the continuum bounded by and including aneurysmdiameters between 4 mm and 5 mm and heights between 6 mm and 8 mm. Theimplant capable of treating aneurysms having the aforementioned sizes,when compressed for delivery through a microcatheter can have a lengthmeasuring between about 22 mm and about 25 mm.

As an alternative to having two distinct implanted shapes, the implantcan have an implanted shape that includes a compaction resistant postextending within an inner sack of the braid and extending between aproximal inversion near an aneurysm neck and a distal inversion near adistal portion of an aneurysm wall. In the implanted shape, the tubularbraid can have an outer layer that corresponds to the outer segment inthe predetermined shape, the inner sack in the implanted shape cancorrespond to the middle segment in the predetermined shape, thecompaction resistant post can correspond to the inner, third segment inthe predetermined shape, and the distal and proximal inversions cancorrespond to the two inversions in the predetermined shape. Thecompaction resistant post can serve to inhibit the implant fromimpacting when implanted in the aneurysm.

An example method of treating an aneurysm can include one or more of thefollowing steps presented in no particular order, and the method caninclude additional steps not included here. A tubular braid having anopen end and a pinched end can be selected and shaped to a predeterminedshape. The predetermined shape can be formed by inverting the braid toform a distal inversion, moving the open end over some or all of thebraid to form a proximal inversion, shaping a first segment that extendsbetween the open end and the proximal inversion, shaping a secondsegment that extends between the two inversions, positioning the openend to encircle the second segment, shaping a third segment that extendsbetween the distal inversion and the pinched end of the braid, andpositioning the second segment to surround the third segment. Formingthe predetermined shape can further include shaping the open end andsecond segment so that the open end has a diameter greater than or equalto the maximum diameter of the second segment.

The tubular braid can be formed in the predetermined shape such that thetubular braid is implantable in two distinct implanted shapes and ineither of two aneurysms having differing heights such that the braidtakes on one implanted shape in the taller aneurysm and the second,different implanted shape in the shorter aneurysm. The example methodcan further include reshaping the tubular braid into one of the twodistinct implanted shapes. When the tubular braid is reshaped for thetaller aneurysm, the first segment can be reshaped to form an outerbraid layer that apposes an aneurysm wall of the taller aneurysm, theproximal inversion can be positioned at the neck of the taller aneurysm,and the second segment can be reshaped to form a sack that nests withinthe outer layer and also apposes the aneurysm wall of the talleraneurysm. When the tubular braid is reshaped for the shorter aneurysm,the first segment can be reshaped to form an outer braid layer thatapposes an aneurysm wall of the shorter aneurysm, the proximal inversioncan be positioned at the neck of the shorter aneurysm, and the secondsegment can be folded to form a middle braid layer that apposes theouter layer and an inner braid layer that apposes the middle layer.

Forming the predetermined shape can further include forming a bend inthe second segment, and when the tubular braid is reshaped for theshorter aneurysm, the second segment can be folded at the bend to formthe fold that separates the middle braid layer and the inner braidlayer.

When the tubular braid is reshaped for the taller aneurysm, the pinchedend can be suspended within the sack. When the tubular braid is reshapedfor the smaller aneurysm, the pinched end can be positioned near theproximal inversion.

When the tubular braid is reshaped for the taller aneurysm, the open endcan encircle the sack. When the tubular braid is reshaped for theshorter aneurysm, the open end can be positioned near the foldseparating the middle braid layer and the inner braid layer.

The method can further include shaping the tubular braid into a deliveryshape to be delivered through a microcatheter. The tubular braid canhave a length in the delivery shape that is measured between the openend and the pinched end. When the tubular braid is shaped to thepredetermined shape, it can be shaped to have an outermost diameter. Thelength of the tubular braid in the delivery shape can measure between3.5 and 5 times that of the outermost diameter of the tubular braid inthe predetermined shape.

In the predetermined shape, the outermost diameter can be shaped to bebetween 2 and 1/3 times the height of the tubular braid.

When the tubular braid is shaped to the predetermined shape, the tubularbraid can be shaped to be suitable to be implanted in an aneurysm havinga diameter of 4 mm and a height of 6 mm, an aneurysm having a diameterof 5 mm and a height of 8 mm, and an aneurysm having a diameter of 6 mmand a height of 6 mm. Additionally, or alternatively, when the tubularbraid is shaped to the predetermined shape, the tubular braid can beshaped to be suitable for treating a continuum of aneurysm sizesincluding aneurysms having diameters between 4 mm and 5 mm and heightsbetween 6 mm and 8 mm. The tubular braid that is suitable for treatinganeurysms sized as above can be extended to a single layer deliveryshape having a length measuring between about 22 mm and about 25 mm, thedelivery shape sized to be delivered through a microcatheter.

The method can further include positioning the proximal inversion on aproximal side of a plane defining a boundary between an aneurysm andblood vessel branches. The first segment can be reshaped to appose ananeurysm wall and the second segment can be reshaped to provide anoutwardly radial force in the plane. The force can be sufficient toappose the first segment to the aneurysm neck. The force can also besufficient to resist compaction of the implant within the aneurysm.

The method can further include collapsing the implant to fit within amicrocatheter and pushing the pinched end of the unsheathed tubularbraid through a majority of the length of the microcatheter to ananeurysm within a patient.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and further aspects of this invention are further discussedwith reference to the following description in conjunction with theaccompanying drawings, in which like numerals indicate like structuralelements and features in various figures. The drawings are notnecessarily to scale, emphasis instead being placed upon illustratingprinciples of the invention. The figures depict one or moreimplementations of the inventive devices, by way of example only, not byway of limitation.

FIG. 1A is an illustration of an example implant having a tubular braidin a predetermined shape according to aspects of the present invention;

FIG. 1B is an illustration of the example implant with the tubular braidin a first implanted shape according to aspects of the presentinvention;

FIG. 1C is an illustration of the example implant with the tubular braidin a second implanted shape according to aspects of the presentinvention;

FIGS. 2A through 2H are illustrations of an implant having a tubularbraid that expands to a predetermined shape similar to as illustrated inFIG. 1A as the tubular braid exits a microcatheter according to aspectsof the present invention;

FIGS. 3A through 3H are illustrations of the implant showing the tubularbraid expanding to a first implanted shape and a second implanted shapewithin an aneurysm according to aspects of the present invention;

FIG. 4A is an illustration of the implant showing the tubular braidexpanded in the first implanted shape in a tube having a 5 mm diameteraccording to aspects of the present invention;

FIG. 4B is an illustration of the implant showing the tubular braidexpanded in the second implanted shape in a tube having a 4 mm diameteraccording to aspects of the present invention;

FIGS. 5A through 5D are illustrations of the example implant asillustrated in FIGS. 1A through 1C implanted in either the firstimplanted shape or the second implanted shape in aneurysms ranging insize according to aspects of the present invention;

FIGS. 6A and 6B are illustrations of measurements of an example implantand an aneurysm according to aspects of the present invention;

FIG. 7A is an illustration of an example implant having a tubular braidin an alternative predetermined shape according to aspects of thepresent invention;

FIG. 7B is an illustration of the example implant illustrated in FIG. 7Awith the tubular braid in an implanted shape according to aspects of thepresent invention;

FIG. 8A is an illustration of an example implant having a tubular braidin another alternative predetermined shape according to aspects of thepresent invention;

FIG. 8B is an illustration of the example implant illustrated in FIG. 8Awith the tubular braid in an implanted shape according to aspects of thepresent invention;

FIG. 9A is an illustration of an example implant having a tubular braidin another alternative predetermined shape according to aspects of thepresent invention;

FIG. 9B is an illustration of the example implant illustrated in FIG. 9Awith the tubular braid in an implanted shape according to aspects of thepresent invention;

FIG. 10 is an illustration of an implant having a tubular braid in apredetermined shape similar to as illustrated in FIG. 9A according toaspects of the present invention; and

FIGS. 11A through 11E are illustrations of the implant illustrated inFIG. 10 showing the tubular braid expanding to the implanted shapesimilar to as illustrated in FIG. 9B according to aspects of the presentinvention.

DETAILED DESCRIPTION

Examples presented herein generally include a braided implant that cansecure within an aneurysm sac and occlude a majority of the aneurysm'sneck. The implant can include a tubular braid that can be set into apredetermined shape, compressed for delivery through a microcatheter,and implanted in at least one implanted position that is based on thepredetermined shape and the geometry of the aneurysm in which the braidis implanted. When compressed, the implant can be sufficiently short tomitigate friction forces produced when the implant is deliveredunsheathed through the microcatheter allowing for a more simplisticdelivery system compared to some other known braided embolic implantdelivery systems

FIGS. 1A through 1C are illustrations of an example braided implant 100that can have a predetermined shape as illustrated in FIG. 1A and twodistinct implanted shapes as illustrated in FIGS. 1B and 1C. The implant100 can treat a range of aneurysm sizes including a larger aneurysm 10 aas illustrated in FIG. 1B and a smaller aneurysm 10 b as illustrated inFIG. 1C. The implant 100 can have a first implanted shape (FIG. 1B) thatcan be conducive for treating larger aneurysms 10 a and a secondimplanted shape (FIG. 1C) that can be conducive for treating smalleraneurysms 10 b. The implant 100 can include a tubular braid 110 havingan open end 114 and a pinched end 112. The implant 100 can include adetachment feature 150 attached to the braid 110 at the pinched end 112.The tubular braid 110 can be formed in the predetermined shape (FIG.1A), collapsed for delivery through a microcatheter, attached to adelivery system at the detachment feature 150, and implanted in a shapesimilar to one or the other of the two implanted shapes (FIG. 1B or FIG.1C).

Referring to FIG. 1A, when in the predetermined shape, the tubular braid110 can include two inversions 122, 124, dividing the braid 110 intothree segments 142, 144, 146. In the predetermined shape, the braid 110can have an outer segment 142 extending from the open end 114 of thebraid 110 to one of the inversions 122, an inner segment 146 extendingfrom the pinched end 112 of the braid 110 to the other of the inversions124, and a middle segment 144 extending between the two inversions 122,124. When in the predetermined shape, the tubular braid 110 can besubstantially radially symmetrical about a central vertical axis y (seeFIG. 6A). FIG. 1A illustrates a profile of each segment 142, 144, 146,and the detachment feature 150 is illustrated as a flat key that can beused with a mechanical implant delivery system (not illustrated).

The tubular braid 110 can be formed into the predetermined shape byfirst inverting the braid outwardly to separate the inner segment 146from the middle segment 144 with an inversion 124, then the middlesegment 144 can be shaped over a form to produce the substantially “S”shaped profile illustrated, and finally, the braid 110 can be invertedoutwardly again to separate the middle segment 144 from the outersegment 142 with another inversion 122. If necessary, the braid can betrimmed at the open end 114. The open end 114 can be positioned toencircle the middle segment 144. The open end 114 can positioned withinthe middle third section of the braid's height as illustrated.

It can be advantageous to minimize a neck opening 126 defined by thelower extension of the “S” shape of the middle segment 144 to maximizeocclusion of an aneurysm neck when the implant 100 is implanted. Themiddle segment 144 can have one or more bends 132, 134. The bends 132,134 can be positioned facilitate the movement of the braid 110 into thesecond implanted shape illustrated in FIG. 1C and the bends 132, 134 canbe positioned to stabilize the braid 110 in the first and/or secondimplanted shape.

The tubular braid 110 can include memory shape material that can be heatset to a predetermined shape, can be deformed for delivery through acatheter, and can self-expand to an implanted shape that is based on thepredetermined shape and confined by the anatomy of the aneurysm in whichit is implanted.

As illustrated in FIG. 1B, when in the first implanted shape, the braid110 can have an outer layer 142 a contacting the aneurysm's wall 14 a, asack 144 a nested within the outer layer 142 a, a proximal inversion 122a positioned at the aneurysm's neck 16 a, and a distal inversion 124 apositioned near a distal portion 15 a of the aneurysm wall 14 a. In thefirst implanted shape, the detachment feature 150 and pinched end 112 ofthe braid 110 can be suspended within the sack 144 a.

As illustrated in FIGS. 1A and 1B, the tubular braid 110 in the firstimplanted shape can be radially compressed and vertically extendedcompared to the predetermined shape. The outer layer 142 a in the firstimplanted shape can correspond to the outer layer 142 in thepredetermined shape, the proximal inversion 122 a in the first implantedshape can correspond to the inversion 122 adjacent to the outer layer142 in the predetermined shape, the sack 144 a in the first implantedshape can correspond to the middle segment 144 in the predeterminedshape, the distal inversion 124 a in the first implanted shape cancorrespond to the inversion 124 adjacent to the inner segment 146 in thepredetermined shape, and an inner braid segment 146 a suspending thedetachment feature 150 in the first implanted shape can correspond tothe inner segment 146 in the predetermined shape. In the first implantedshape, the sack 144 a can have a neck opening 126 a corresponding to theneck opening 126 in the predetermined shape.

As illustrated in FIG. 1C, when in the second implanted shape, the braid110 can have an outer layer 142 b contacting the aneurysm's wall 14 b, aproximal inversion 122 b positioned at the aneurysm's neck 16 b, amiddle layer 144 b extending within the outer layer 142 b and pressingagainst the outer layer 142 b, a distal inversion 124 b positioned nearthe open end 114 of the braid 110, and an inner layer 146 b extendingwithin the middle layer 144 b and pressing against the middle layer 144b. In the second implanted shape, the detachment feature 150 and pinchedend 112 of the braid 110 can be positioned at the aneurysm neck 16 b,near the proximal inversion 122 b.

As illustrated in FIGS. 1A and 1C, the tubular braid 110 in the secondimplanted shape can be radially compressed compared to the predeterminedshape, and the middle segment 144 of the predetermined shape can befolded so that the height of the tubular braid 110 is compressed in thesecond implanted shape compared to the predetermined shape.Alternatively, when implanted in the second implanted shape in aneurysmshaving a diameter that is significantly smaller than the aneurysm'sheight, the second implanted shape can be radially compressed comparedto the predetermined shape and the height of the braid in the secondimplanted shape can be greater than the height of the braid in thepredetermined shape.

The outer layer 142 b in the second implanted shape can correspond tothe outer layer 142 in the predetermined shape, the proximal inversion122 b in the second implanted shape can correspond to the inversion 122adjacent to the outer layer 142 in the predetermined shape, the middlelayer 144 b and inner layer 146 b in the second implanted shape cancorrespond to the middle segment 144 in the predetermined shape, thedistal inversion 124 b in the second implanted shape can correspond to abend 134 in the middle segment 144 in the predetermined shape, and aportion of the braid 110 near the detachment feature 150 forming theinner layer 146 b in the second implanted shape can correspond to theinner segment 146 in the predetermined shape.

FIGS. 2A through 2H are illustrations of an example implant 100 having abraid 110 expanding to a predetermined shape as the braid 110 exits amicrocatheter 600. The implant 100 has a predetermined shape similar toas illustrated in FIG. 1A. As illustrated in FIG. 2A, the braid 110 canbe shaped to a delivery shape that is extended to a single layer oftubular braid having a compressed circumference/diameter sized to bedelivered through the microcatheter 600 and a length L. The illustratedimplant 100 has a length L of between about 22 mm and about 25 mm. Aswill be appreciated and understood by a person of ordinary skill in theart, the length L of a specific braid 110 can be tailored based on thesize and shape of the aneurysm being treated.

During delivery through the microcatheter 600, the detachment feature150 can be attached to a delivery system at a proximal end of theimplant 100, the pinched end 112 can be positioned near the proximal endof the implant 100, and the open end 114 can define the distal end ofthe implant 100. Collapsing the braid 110 to a single layer tube canresult in a braid 110 that has a sufficiently small diameter and asufficiently short length L to mitigate effects of friction force on thebraid 110 when it is delivered through the microcatheter, allowing thebraid 110 to be delivered unsheathed in some applications.

As illustrated in FIG. 2B, the open end 114 can be positioned to exitthe microcatheter 600 before any other portion of the braid 110 exitsthe microcatheter. The open end 114 can expand as it exits themicrocatheter 600. If the open end 114 is unconstrained by an aneurysmas illustrated, the open end can expand to its circumference in thepredetermined shape.

As illustrated in FIG. 2C, the distal portion of the braid 110 cancontinue to expand radially as it exits the microcatheter 600.

As illustrated in FIG. 2D, the braid 110 can form the inversion 122defining the outer segment 142 as the braid 110 is further pushed out ofthe microcatheter 600.

As illustrated in FIGS. 2E through 2G, the “S” shape of the middlesegment 144 can begin to form as the braid 110 is further pushed fromthe microcatheter 600.

As illustrated in FIG. 2H, when all, or nearly all of the braid 110exits the microcatheter 600, the braid 110, not confined by an aneurysm,can expand to a predetermined shape similar to the shape illustrated inFIG. 1A. In the predetermined shape, the braid 110 of the illustratedimplant has a diameter between about 6 mm and about 6.5 mm and a heightbetween about 5 mm and about 5.5 mm.

The ratio of the outermost diameter of the braid 110 in thepredetermined shape illustrated in FIG. 2H to the length of the braid110 in the delivery shape illustrated in FIG. 2A is between about 0.3and about 0.24.

FIGS. 3A through 3H are illustrations of the implant 100 illustrated inFIGS. 2A through 2H expanding within an aneurysm 10 in two differentimplanted shapes. The aneurysm 10 has a height of about 6 mm, a diameterof about 6 mm, and a neck diameter of about 4 mm. Comparing thedimensions of the aneurysm 10 to the braid 110 in the predeterminedshape illustrated in FIG. 2H, the braid 110 has a slightly largerdiameter and a slightly smaller height, and the interior of the aneurysm10 is substantially spherical while the outer dimensions of the braid110 are more cylindrical (see FIGS. 6A and 6B for measurementorientation). When the braid 110 of the implant 100 is confined by theaneurysm 10, the braid 110 is therefore be radially constrained.

As illustrated in FIG. 3A, the implant 100 can be delivered to theaneurysm 10 through the microcatheter 600, as described in relation toFIG. 2A. The open end 114 of the tubular braid 110 can expand within theaneurysm 10 as it exits the microcatheter 600. The illustrated aneurysm10 is positioned at a bifurcation including a stem blood vessel 20 andtwo branch vessels 22 a, 22 b, and the microcatheter 600 is illustratedbeing delivered through the stem blood vessel 20. It is contemplatedthat the implant could be delivered to an aneurysm on a sidewall of ablood vessel through a curved microcatheter, and such a procedure isintended to be embraced by the scope of the present disclosure.

As illustrated in FIG. 3B, as the braid 110 is further pushed distallyfrom the microcatheter 600, the braid 110 can expand to appose theaneurysm wall 14 and conform to the aneurysm neck 16. The aneurysm 10being treated can have a diameter that is less than the outer diameterof the tubular braid 110 in the predetermined shape so that the braid110 tends to expand outwardly, providing a force against the aneurysmwall 14, and sealing around the perimeter of the aneurysm neck 16. Theimplant 100 can be particularly suitable for treating a wide neckaneurysm such as commonly occur at bifurcations because the radial forceprovided by the braid 110 against the aneurysm wall 14 and perimeter ofthe neck 16 can be sufficient to both anchor the implant 100 in a wideneck aneurysm and seal the neck 16 of the aneurysm 10.

As illustrated in FIG. 3C, as the braid 110 is further pushed distallyfrom the microcatheter 600, the proximal inversion 122 a can be formed.

As illustrated in FIG. 3D, the microcatheter 600 can be manipulated toplace the proximal inversion 122 a at the aneurysm neck 16. The proximalinversion 122 a can be placed on a proximal side of a plane defining aboundary 18 (See FIG. 6B) between the aneurysm 10 and the branch vessels22 a, 22 b. In some applications it can be advantageous to place theproximal inversion 122 a far enough in the proximal direction from theplane 18 so that the outer layer 142 a of the braid 110 seals around theouter perimeter of the aneurysm neck 16, but not so far proximally thatthe implant 100 becomes an obstruction to the blood vessels 22 a, 22 b,20.

As illustrated in FIG. 3E, the braid 110 can expand within the aneurysmsac 12 and extend to appose an inner surface of the outer layer 142 a ofthe braid 110. The apposition to the outer layer 142 a can provideadditional force to anchor the outer layer 142 a to the aneurysm wall14.

As illustrated in FIG. 3F, the aneurysm 10 has a height that canaccommodate the tubular braid 110 in the first implanted shape similarto that illustrated in FIG. 1B. Because the braid 110 is radiallyconstrained and has a more cylindrical shape compared to thesubstantially spherical shape of the aneurysm, the braid 110 can extendbeyond the height of the predetermined shape to accommodate aneurysmstaller than the predetermined shape. In the illustration, the tubularbraid 110 of the implant 100 in the predetermined shape has a heightbetween about 0.5 mm and 1 mm less than the height of the aneurysm, orin other words, the implant has extended between about 10% and about 20%in height in the first implanted shape compared to the predeterminedshape.

The braid can be pulled proximally as illustrated in FIG. 3G to form asecond implanted shape as illustrated in FIG. 3H that is similar to thesecond implanted shape illustrated in FIG. 1C, but different in that theaneurysm 10 b illustrated in FIG. 1C is smaller (proportionally comparedto the braid 110) than the mock aneurysm 10 illustrated in FIG. 3H.Before the implant 100 is released from the delivery system, the implant100 can be partially or fully retracted into the microcatheter 600 andrepositioned in either of the first implanted shape or the secondimplanted shape. Additionally, or alternatively, the microcatheter 600can be moved distally to move the braid 110 from the second implantedshape illustrated in FIG. 3H to the first implanted shape illustrated inFIG. 3F. In some applications, while positioning the implant 100, aphysician can choose whether the first implanted shape or the secondimplanted shape is more suitable for the anatomy of the aneurysm andtreatment site. For treatments involving aneurysms and implants shapedsimilar to the aneurysm 10 and implant 100 illustrated in FIGS. 3Athrough 3H, it can be more advantageous to shape the braid 110 in thefirst implanted shape as illustrated in FIG. 3F (rather than the secondimplanted shape illustrated in FIG. 3G) because the first implantedshape in this example implementation provides a larger surface area ofthe braid 110 in contact with the aneurysm wall 14.

FIGS. 4A and 4B are illustrations of the braid 110 of the exampleimplant illustrated in FIGS. 2A through 2H and 3A through 3H showing thetubular braid 110 expanded within tubes to determine a range of aneurysmdiameters and aneurysm heights that an implant 100 having the dimensionsof the example implant 100 would be suitable for treating. FIG. 4Aillustrates the braid 110 in a tube having a 5 mm diameter. The braid110 is in the first implanted shape and has a height of about 8 mm. Thebraid 110 is therefore radially constrained from its predetermined shapeby between about 1 mm and 1.5 mm in diameter, or between about 17% and23%, and expanded vertically in height by between about 2.5 mm and 3 mm,or between about 45% and 60%.

FIG. 4B illustrates the braid 110 in a tube having a 4 mm diameter. Thebraid 110 is in the second implanted shape and has a height of about 6mm. The braid is therefore radially constrained from its predeterminedshape by between about 2 mm and 2.5 mm in diameter, or between about 33%and 38%, and expanded vertically between about 0.5 mm and 1 mm, orbetween about 10% and 20%.

Implants having a predetermined shape and dimensions as illustrated anddescribed in relation to FIG. 2H can therefore be suitable for treatinganeurysms having a diameter between and including about 4 mm and about 5mm and a height between and including about 6 mm and about 8 mm. Asillustrated in FIG. 3F, the implant can also be suitable for treating ananeurysm having a diameter of 6 mm and a height of 6 mm. As will beappreciated and understood by a person of ordinary skill in the art, thedimensions of the tubular braid in the predetermined shape can betailored to treat aneurysms within a range of sizes not specificallyoutlined herein according to the principles described herein. It iscontemplated that a collection of implants so shaped can be madeavailable to physicians, and a physician can choose a suitable implantfrom the collection based on aneurysm height, diameter, neck diameter,and/or other anatomical features.

A collection of implants, each having a uniquely shaped tubular braidcan be created to provide a catalogue of implants for treating aneurysmsranging in diameter and height. The catalogue can include implantssuitable for treating aneurysms ranging from 3 mm to 15 mm in diameterand ranging from 3 mm to 15 mm in height, or in another example, rangingfrom 3 to 11 mm in diameter and 3 to 7 mm in height. As will beappreciated and understood by a person of ordinary skill in the art,some aneurysm dimensions are extremely rare, and the catalog need notinclude implants for treating aneurysms having a large height:diameterratio or a large diameter:height ratio.

Each implant in the collection can be suitable for treating aneurysmswith a sub range of diameters and a sub-range of heights. An examplecatalogue can include a listing of implants for treating aneurysms ofone or more of, but not limited to, the following size sub ranges(diameter range in mm, height range in mm): (3-5, 3-5), (6-8, 4-5), and(9-11, 5-7).

In some examples, each size sub range can be treated by a single implanthaving a tubular braid uniquely sized and shaped to be suitable fortreating aneurysms within that sub range. In some examples, the subranges in the catalogue can be represented by implants each having atubular braid with a delivery length (length when the braid is collapsedfor delivery through a microcatheter) that is about 10 mm, about 40 mm,and/or including a length in between.

As will be appreciated and understood by a person of ordinary skill inthe art, aneurysm height and diameter are measured with some margin oferror. To that end, the size sub range included in the catalogue for agiven implant can represent a portion of aneurysm sizes that can betreated with the implant and the implant can treat aneurysms outside ofthe listed sub range. For instance, an implant listed for treatinganeurysms having heights between height a and height b and diameterrange between diameter x and diameter y can be suitable for treatinganeurysms slightly taller than the maximum listed height b if thediameter of the aneurysm is near the lower limit of the range (aboutdiameter x), the implant can be suitable for treating diameters slightlylarger than diameter y if the height of the aneurysm is near the lowerlimit of the height range (about height a).

FIGS. 5A through 5D are illustrations of the example implant 100 asillustrated in FIGS. 1A through 1C implanted in either the firstimplanted shape or the second implanted shape in aneurysms ranging insize. FIG. 5A illustrates a large aneurysm 10 a, FIGS. 5B and 5Cillustrate a medium aneurysm 10 c, and FIG. 5D illustrates a smallaneurysm 10 b. The implant 100 is advantageously implanted in ananeurysm 10 a, 10 b, 10 c having a diameter about equal to or smallerthan the diameter of the braid 110 in the predetermined shape so thatthe braid 110 provides an outward force F against the aneurysm wall 14when implanted. The braid 110 can have inner layers that press againstone or more outer layers, contributing to the force F.

As illustrated in FIG. 5A, the maximum size of an aneurysm 10 a that theimplant 100 can be suitable for treating can be determined by thedimensions that the braid 110 can take in the first implanted shape. Thepinched end 112 and detachment feature 150 can be positioned near adistal portion 15 a of the aneurysm wall 14 a as similarly illustratedin FIG. 1B.

As illustrated in FIG. 5B, the implant 100 can also be suitable fortreating a medium sized aneurysm 10 c that is smaller than the aneurysm10 a illustrated in FIG. 5A in the first implanted shape. To fit withinthe medium aneurysm 10 c in the first implanted shape, the pinched end112 and detachment feature 150 can be positioned away from the distalportion 15 c of the aneurysm wall compared to the position of thepinched end 112 and detachment feature 150 in the large aneurysm 10 a.In the predetermined shape (see FIG. 1A), the middle segment 144 caninclude a bend 134 to stabilize the tubular braid 110 in the firstimplanted shape in the medium aneurysm 10 c as illustrated in FIG. 5B.

As illustrated in FIG. 5C, the implant 100 can also be suitable fortreating the medium sized aneurysm 10 c in the second implanted shape.The middle segment 144 of the braid in the predetermined shape (see FIG.1A) can be folded to form a middle layer 144 b and an inner layer 146 bsimilar to as described in relation to FIG. 1C. In some applications,either implanted shape could be effective for treating the aneurysm 10c, and a physician can select a preferred shape during treatment. Forinstance, a physician can decide to use the first implanted shape (FIG.5B) to elongate the implant so that the proximal fold 122 a can beplaced proximally outside of the aneurysm neck, or the physician candecide to use the second implanted shape (FIG. 5C) to provide morelayers of braid at the aneurysm neck to occlude the neck opening 16 c.

As illustrated in FIG. 5D, the minimum size of aneurysm 10 b that theimplant 100 can be suitable for treating can be determined by thedimensions that the braid 110 can take in the second implanted shape.The open end 114 and/or the distal fold 124 b can be collapsed near adistal portion 15 b of the aneurysm wall in the second implanted shape.

FIG. 6A is an illustration of height HI and diameter D1, D2 measurementsof an example implant 100 in a predetermined shape. In the predeterminedshape, the braid 110 of the example implant 100 can be substantiallyradially symmetrical about vertical axis y, and therefore can havesubstantially circular concentric cross-sections each describable by itsdiameter. FIG. 6A highlights the height HI of the implant 100 in apredetermined shape measured between the inversions 122, 124, the outerdiameter D1 of the outer segment 142, which corresponds to the diameterof the open end 114, and the outer diameter D2 of the middle segment D2.Although FIG. 6A illustrates only one example predetermined shape, itshould be understood that the height and diameter of example implantsdescribed herein 100, 200, 300, 400 and portions thereof can be measuredsimilarly to as illustrated in FIG. 6A.

FIG. 6B is an illustration of height HA, sac diameter DA, and neckdiameter DN measurements of an aneurysm 10. The location of the plane 18defining a boundary between the aneurysm 10 and blood vessels is alsoillustrated.

FIG. 7A is an illustration of an example implant 200 having a tubularbraid 210 in an alternative predetermined shape. FIG. 7B is anillustration of the example implant 200 in an aneurysm 10 with thetubular braid 210 in an implanted shape. The tubular braid 210 can havean open end 214 and a pinched end 212. The implant 200 can include adetachment feature 150 attached to the braid 210 at the pinched end 212.The braid 210 can be formed in the predetermined shape, collapsed fordelivery through a microcatheter, attached to a delivery system at thedetachment feature 150, and implanted in the implanted shape.

As illustrated in FIG. 7A, when in the predetermined shape, the tubularbraid 210 can include two inversions 222, 224, dividing the braid 210into three segments 242, 244, 248. In the predetermined shape, the braid210 can have an outer segment 242 extending from the open end 214 of thebraid 210 to one of the inversions 222, an inner segment 248 extendingfrom the pinched end 212 of the braid 210 to the other of the inversions224, and a middle segment 244 extending between the two inversions 222,224. When in the predetermined shape, the tubular braid 210 can besubstantially radially symmetrical about a central vertical axis y (seeFIG. 6A). FIG. 7A illustrates a profile of each segment 242, 244, 248.

Comparing the predetermined shape of the braid 210 illustrated in FIG.7A to that of the braid 110 illustrated in FIG. 1A, the outer segments142, 242 and middle segments 144, 244 are respectively similar to eachother, and the inner segment 248 of the braid 210 illustrated in FIG. 7Ais longer than the inner segment 146 of the braid 110 illustrated inFIG. 1A. The pinched end 212 of the braid 210 in FIG. 7A is positionednear the inversion 222 adjacent the outer segment 242 rather than nearthe inversion 124 near the inner segment 146 as illustrated in FIG. 1A.The elongated inner segment 248 illustrated in FIG. 7A can be positionedto help the implant 200 resist compaction when implanted as illustratedin FIG. 7B.

The tubular braid 210 illustrated in FIG. 7A can be formed into thepredetermined shape similar to as described in relation to FIG. 1A withsome differences. The middle segment 244 need not have bends 132, 134positioned facilitate the movement of the braid 210 into a secondimplanted shape. The inner segment 248 as illustrated in FIG. 7A can bemade longer than that illustrated in FIG. 1A. The inner segment 248 canbe shaped to have a length that is optimized to reduce the likelihoodthat the implant 200 can become compacted when implanted.

An implant 200 having a braid 210 having a predetermined shape asillustrated in FIG. 7A can have outer dimensions in the predeterminedshape including an outer diameter and height similar to as illustratedand described in relation to FIG. 2H. The inner segment 248 of the braid210 illustrated in FIG. 7A can have a height that is approximately equalto the height of the braid 210 in the predetermined shape.

The braid 210 can be elongated to a single layer tubular braid in adelivery shape that is sized to traverse a microcatheter. The length ofthe braid 210 in the delivery shape can be measured from the open end214 to the pinched end 212. A braid 210 having a predetermined shape asillustrated in FIG. 7A and outer dimensions as illustrated and describedin relation to FIG. 2H can have a length in the delivery shape that islonger compared to the length of the braid 110 illustrated in FIG. 2A.The length of the braid 210 illustrated in FIG. 7A when in the deliveryshape can be longer than a braid 110 having a predetermined shape asillustrated in FIG. 1A by about the height of the braid 110, 210 in thepredetermined shape. In other words, an implant 200 having a braid 210with a predetermined shape as illustrated in FIG. 7A can have an outerdiameter between about 6 mm and about 6.5 mm and a height between about5 mm and 5.5 mm when in the predetermined shape and can be elongated toa single layer tube having a circumference collapsed to fit within amicrocatheter and a length measuring between about 27 mm and 30 mm. Theratio of outermost diameter in the predetermined shape to length in thedelivery shape can be between about 0.24 and about 0.2.

As illustrated in FIG. 7B, when in the implanted shape, the braid 210can have an outer layer 242 a contacting the aneurysm's wall 14, a sack244 a nested within the outer layer 242 a, a proximal inversion 222 apositioned at the aneurysm's neck 16, and a distal inversion 224 apositioned near a distal portion 15 of the aneurysm wall 14. Thedetachment feature 150 and pinched end 212 of the braid 210 can bepositioned near the aneurysm neck 16, near the proximal inversion 222 a.The detachment feature 150 and pinched end 212 can be positioned toreduce the likelihood that the implant 200 becomes impacted.

FIG. 8A is an illustration of an example implant 300 having a tubularbraid 310 in another alternative predetermined shape. FIG. 8B is anillustration of the example implant 300 when the tubular braid 310 in animplanted shape. The tubular braid 310 can have an open end 314 and apinched end 312, and a detachment feature 150 can be attached to thebraid 310 at the pinched end 312. The braid 310 can be formed in thepredetermined shape, collapsed for delivery through a microcatheter,attached to a delivery system at the detachment feature 150, andimplanted in the implanted shape.

As illustrated in FIG. 8A, when in the predetermined shape, the tubularbraid 310 can include two inversions 322, 324, dividing the braid 310into three segments 342, 344, 346. In the predetermined shape, the braid310 can have an outer segment 342 extending from the open end 314 of thebraid 310 to one of the inversions 322, an inner segment 346 extendingfrom the pinched end 312 of the braid 310 to the other of the inversions324, and a middle segment 344 extending between the two inversions 322,324. When in the predetermined shape, the tubular braid 310 can besubstantially radially symmetrical about a central vertical axis. FIG.8A illustrates a profile of each segment 342, 344, 346.

Comparing the predetermined shape of the braid 310 illustrated in FIG.8A to that of the braid 110 illustrated in FIG. 1A, the outer segments142, 342 and inner segments 146, 346 are respectively similar to eachother, and the middle segment 344 of the braid 310 illustrated in FIG.8A has an undulating pattern rather than the “S” shape of the middlesegment 144 of the braid 110 illustrated in FIG. 1A. The undulatingmiddle segment 344 can be radially symmetrical to form a honeycombshape. When implanted, the middle segment 344 in the undulating patterncan provide a force pattern pressing outwardly to anchor the implant 300within an aneurysm that is different from a force pattern that could beprovided by the middle segment 144 having the “S” shape illustrated inFIG. 1A. The pinched end 312 of the braid 310 in FIG. 8A can bepositioned near the inversion 324 adjacent the inner segment 346 asillustrated. Alternatively, the inner segment 346 can be shaped toextend to the inversion 322 adjacent the outer segment 342 to provide acompaction resistant column.

The tubular braid 310 illustrated in FIG. 8A can be formed into thepredetermined shape similar to as described in relation to FIG. 1A withsome differences. The middle segment 344 can be formed to have anundulating pattern rather than an “S” shaped pattern. The middle segment344 need not have bends positioned facilitate the movement of the braid310 into a second implanted shape.

As illustrated in FIG. 8B, when in the implanted shape, the braid 310can have an outer layer 342 a shaped to contact an aneurysm wall,compressed extensions of an undulating middle layer 344 a nested withinthe outer layer 342 a, a proximal inversion 322 a positioned to beplaced an aneurysm neck, and a distal inversion 324 a positioned to beplaced near a distal portion of the aneurysm wall. The detachmentfeature 150 and pinched end 312 of the braid 310 can be positionedwithin the aneurysm sac, either near the distal inversion 324 a asillustrated, near the proximal inversion 322 a, or at a position inbetween. The detachment feature 150 and pinched end 312 can bepositioned to reduce the likelihood that the implant 300 becomesimpacted.

FIG. 9A is an illustration of an example implant 400 having a tubularbraid 410 in another alternative predetermined shape. FIG. 9B is anillustration of the example implant 400 illustrating the tubular braid410 in an implanted shape. The tubular braid 410 can have an open end414 and a pinched end 412. A detachment feature 150 can be attached tothe braid 410 at the pinched end 412. The implant 400 can be formed inthe predetermined shape, collapsed for delivery through a microcatheter,attached to a delivery system at the detachment feature 150, andimplanted in the implanted shape.

As illustrated in FIG. 9A, when in the predetermined shape, the tubularbraid 410 can include two inversions 422, 424, dividing the braid 410into three segments 442, 444, 446. In the predetermined shape, the braid410 can have an outer segment 442 extending from the open end 414 of thebraid 410 to one of the inversions 422, an inner segment 446 extendingfrom the pinched end 412 of the braid 410 to the other of the inversions424, and a middle segment 444 extending between the two inversions 422,424. When in the predetermined shape, the tubular braid 410 can besubstantially radially symmetrical about a central vertical axis y (seeFIG. 6A). FIG. 9A illustrates a profile of each segment 442, 444, 446.

Comparing the predetermined shape of the braid 410 illustrated in FIG.9A to that of the braid 110 illustrated in FIG. 1A, the outer segments142, 442 can be similar to each other, the middle segment 444 of thebraid 410 illustrated in FIG. 9A can have a less pronounced “S” shapecompared to the “S” shaped middle segment 144 illustrated in FIG. 1A,and the inner segment 446 can be conical or “V” shaped in profile withthe pinch end 412 positioned near the inversion 422 adjacent the outerlayer 442 rather than near the inversion 142 adjacent the inner layer146 as illustrated in FIG. 1A. When implanted, the inner segment 446 canreshape to form a compaction resistant column.

The tubular braid 410 illustrated in FIG. 9A can be formed into thepredetermined shape similar to as described in relation to FIG. 1A withsome differences. The middle segment 444 illustrated in FIG. 9A can beformed to have a less pronounced “S” shape pattern compared to the “S”shaped pattern 144 illustrated in FIG. 1A. The middle segment 444 neednot have bends positioned facilitate the movement of the braid 410 intoa second implanted shape. The inner segment 446 can have a longer lengthas illustrated in FIG. 9A compared to the inner segment 146 illustratedin FIG. 1A. The inversion 424 adjacent the inner segment 446 can have amore acute curvature as illustrated in FIG. 9A compared to thecorresponding inversion 124 illustrated in FIG. 1A.

As illustrated in FIG. 9B, when in the implanted shape, the braid 410can have an outer layer 442 a shaped to contact an aneurysm wall, atulip or heart shaped sack 444 a nested within the outer layer 442 a, aproximal inversion 422 a positioned to be placed at an aneurysm neck, adistal inversion 424 a positioned to be placed near a distal portion ofthe aneurysm wall, and a compaction resistant column 446 a extendingwithin the sack 444 a. The detachment feature 150 and pinched end 412 ofthe braid 410 can be positioned within the sack 444 a near the proximalinversion 422 a. The detachment feature 150 and pinched end 412 can bepositioned to reduce the likelihood that the implant 400 becomesimpacted.

FIG. 10 is an illustration of an example implant 400 having a tubularbraid 410 in a predetermined shape similar to as illustrated in FIG. 9A.

FIGS. 11A through 11E are illustrations of the example implant 400illustrated in FIG. 10 showing the tubular braid 410 expanding to theimplanted shape within a mock aneurysm 10 similar to as illustrated inFIG. 9B. As illustrated in FIG. 11A, the open end 414 can exit themicrocatheter first and expand within the aneurysm 10. As illustrated inFIG. 11B, a distal portion of the braid 410 corresponding to the outerlayer 442 in the predetermined shape can expand to appose the aneurysmwall 14 forming the outer later 442 a in the implanted shape. Asillustrated in FIG. 11C, the braid 410 can begin to invert as the braid410 is further pushed distally from the microcatheter 600. Asillustrated in FIG. 11D, the proximal inversion 422 a can be placed atthe aneurysm neck 16 as the tulip shaped sack 444 a expands within theouter layer 442 a. As illustrated in FIG. 11E, the braid 410 can beshaped in the implanted shape within the aneurysm 10 similar to asillustrated in FIG. 9B.

The tubular braid 110, 210, 310, 410 of the example implants 100, 200,300, 400 can include memory shape material that can be heat set to apredetermined shape, can be deformed for delivery through a catheter,and can self-expand to an implanted shape that is based on thepredetermined shape and confined by the anatomy of the aneurysm in whichit is implanted.

The example implants 100, 200, 300, 400 described herein can rely on aradial outward force to anchor the implant within the sac of ananeurysm. To this end, the braid 110, 210, 310, 410 can be shaped to apredetermined shape having a diameter that is greater than its height sothat the braid is radially constricted when implanted in an aneurysm.The ratio of diameter to height of the braid 110, 210, 310, 410 in arespective predetermined shape can be within the range of 2:1 to 1:3 totreat aneurysms of many known sizes and shapes.

The descriptions contained herein are examples of embodiments of theinvention and are not intended in any way to limit the scope of theinvention. As described herein, the invention contemplates manyvariations and modifications of the implant, including alternativematerials, alternative geometries, alternative detachment features,alternative delivery systems, alternative means for forming a braid intoa predetermined shape, alternative treatment methods, etc. Thesemodifications would be apparent to those having ordinary skill in theart to which this invention relates and are intended to be within thescope of the claims which follow.

What is claimed is:
 1. An implant comprising: a tubular braid comprisingan open end, a pinched end, and a predetermined shape; wherein, in thepredetermined shape, the tubular braid comprises: a first segmentextending from the open end to a first inversion, a second segmentencircled by the open end such that the second segment is only partiallysurrounded by the first segment and extending from the first inversionto a second inversion, and a third segment surrounded by the secondsegment and extending from the second inversion to the pinched end. 2.The implant of claim 1, wherein, when the tubular braid is in thepredetermined shape, the open end comprises a diameter approximatelyequal to a maximum diameter of the second segment.
 3. The implant ofclaim 1, wherein the tubular braid is stable in a first implanted shapebased on the predetermined shape when constrained by a firstsubstantially spherical cavity and the tubular braid is stable in asecond implanted shape based on the predetermined shape when constrainedby a second substantially spherical cavity; wherein, in each of thefirst implanted shape and the second implanted shape, the tubular braidcomprises an outer layer corresponding to the first segment of thepredetermined shape and a proximal inversion corresponding to the firstinversion of the predetermined shape, wherein, in the first implantedshape, the outer layer is positioned to contact a cavity wall of thefirst substantially spherical cavity, and the proximal inversion ispositioned to be placed approximate an entrance of the firstsubstantially spherical cavity; wherein, in the first implanted shape,the tubular braid comprises a sack corresponding to the second segmentof the predetermined shape, and the sack is positioned to appose aportion of an cavity wall of the first substantially spherical cavityand the sack apposes the outer layer; wherein, in the second implantedshape, the outer layer is positioned to contact a cavity wall of thesecond substantially spherical cavity, and the proximal inversion ispositioned to be placed approximate an entrance of the secondsubstantially spherical cavity; and wherein, in the second implantedshape, the tubular braid comprises a middle layer apposing the outerlayer and an inner layer apposing the middle layer, the middle layer andthe inner layer correspond to the second segment of the predeterminedshape, and a fold separates the middle layer and the inner layer.
 4. Theimplant of claim 3, wherein, in the predetermined shape, the tubularbraid comprises a bend positioned in the second segment; and wherein,when the tubular braid is in the second implanted shape, the foldseparating the middle layer and the inner layer corresponds to the bendin the second segment of the predetermined shape.
 5. The implant ofclaim 3, wherein, when the tubular braid is in the first implantedshape, the open end encircles the sack; and wherein, when the tubularbraid is in the second implanted shape, the open end encircles the fold.6. The implant of claim 1, wherein, the tubular braid further comprisesan implanted shape; and wherein in the implanted shape, the tubularbraid comprises an outer layer positioned to appose an aneurysm wall, aninner sack positioned to appose a portion of an aneurysm wall and toappose the outer layer, a proximal inversion positioned to be placedapproximate an aneurysm neck, a distal inversion positioned to be placedapproximate a distal portion of the aneurysm wall, and a compactionresistant post extending centrally within the inner sack and along amajority of a length between the distal inversion and the proximalinversion; and wherein, the outer layer in the implanted shapecorresponds to the first segment in the predetermined shape, the innersack in the implanted shape corresponds to the second segment in thepredetermined shape, the proximal inversion in the implanted shapecorresponds to the first inversion in the predetermined shape, thedistal inversion in the implanted shape corresponds to the secondinversion in the predetermined shape, and the compaction resistant postin the implanted shape corresponds to the third segment in thepredetermined shape.
 7. The implant of claim 1, wherein the implant isconfigured to treat a first aneurysm comprising a first diametermeasuring about 4 mm and a first height measuring about 6 mm, a secondaneurysm comprising a second diameter measuring about 5 mm and a secondheight measuring about 8 mm, and a third aneurysm comprising a thirddiameter measuring about 6 mm and a third height measuring about 6 mm.8. The implant of claim 1, wherein the implant is configured to treat aplurality of aneurysms within a continuum of aneurysm sizes, thecontinuum bounded by and including diameters between about 4 mm andabout 5 mm and heights between about 6 mm and about 8 mm.
 9. An implantcomprising: a tubular braid comprising an open end, a pinched end, and apredetermined shape; wherein, in the predetermined shape, the tubularbraid comprises a first segment extending from the open end to a firstinversion, a second segment encircled by the open end and extending fromthe first inversion to a second inversion, and a third segmentsurrounded by the second segment and extending from the second inversionto the pinched end, wherein the tubular braid is stable in a firstimplanted shape based on the predetermined shape when constrained by afirst substantially spherical cavity and the tubular braid is stable ina second implanted shape based on the predetermined shape whenconstrained by a second substantially spherical cavity, wherein, in eachof the first implanted shape and the second implanted shape, the tubularbraid comprises a proximal inversion corresponding to the firstinversion of the predetermined shape, wherein, when the tubular braid isin the first implanted shape, the pinched end is suspended within a sackcorresponding to the second segment in the predetermined shape; andwherein, when the tubular braid is in the second implanted shape, thepinched end is encircled by the proximal inversion and the tubular braidcomprises a middle layer, an inner layer apposing the middle layer, anda fold separating the middle layer and inner layer, the middle layer,the inner layer, and the fold corresponding to the second segment of thepredetermined shape.